Prompt Reversal of Airway Obstruction Secondary to Angiotensin Converting Enzyme Inhibitor (ACEI) Induced Angioedema by Ecallantide: A Case Report

Case: A 54 year old African-American male with a history of hypertension treated with lisinopril daily, remote cocaine abuse associated myocardial infarction, seizures and prostate cancer, presented with a 2 day history of facial and throat swelling along with dysphagia. He was treated in the emergency department with intravenous methylprednisolone, epinephrine and diphenhydramine. He was admitted, but angioedema progressed overnight, confirmed by laryngoscopy. ICU transfer and intubation was undertaken the next morning for airway protection. Tryptase level was 2 ng/ml. C3 and C4 and routine chemistries were normal. Ecallantide 30mg was administered subcutaneously at 1014 hours. Presented at: American Academy of Allergy Asthma and Immunology annual conference in Orlando Florida

Successful Implementation of the ABCDEF Bundle in the MICU through Interprofessional Collaboration and Teamwork

Earlier this year, members of the medical intensive care unit (MICU) attended an interprofessional workshop that utilized Awakening/Breathing/Choice of Sedation/Delirium/Early Mobility (ABCDE) bundle simulation combined with TeamSTEPPS training to empower care givers to advocate for patient safety while optimizing patient care. The ABCDE bundle is an evidence-based tool designed to implement pain, agitation, and delirium guideline recommendations into routine practice. To further improve patient safety and outcomes and build upon the ABCDE concept, the MICU team developed an interprofession-al practice project by adding routine assessment of need for indwelling Foley catheters to their daily work list, creating the “ABCDEF” bundle

Teaching TeamSTEPPS to Interprofessional Students or Staff to Promote Teamwork and Patient Safety

TeamSTEPPS stands for Team Strategies and Tools to Enhance Performance and Patient Safety

Home Production Technology and Time Allocation: Empirics, Theory, and Implications

We document a set of time use patterns in both time series and cross sections. To explain these facts, we propose and estimate a model of time allocation that emphasizes the role of home production technology. We find it necessary to consider both labor-augmenting technology and total factor productivity in home production. Based on the estimated model, we study the effects of proportional tax and lump-sum transfer on time allocation and labor supply, with the roles of home production technology and wage heterogeneity highlighted

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Forces Shaping Hours Worked in the OECD, 1960-2004

The goal of this paper is to examine the role of taxes and productivity growth as forces influencing market hours. To achieve this goal, the paper considers a calibrated growth model extended to include home production and subsistence consumption, both of which are found to be key features influencing market hours. The model is simulated for 15 OECD countries. The primary force driving changes in market hours is found to be changing labor income tax rates. Productivity catch-up relative to the United States is found to be an important secondary force. (JEL E24, H24, H31, J22, J24)

Demographics and the politics of capital taxation in a life-cycle economy

This article studies the effects of demographics on the mix of tax rates on labor and capital. It uses a quantitative general-equilibrium, overlapping-generationsmodel where tax rates are voted without past commitments in every period and characterized as a Markov equilibrium. In the United States, the younger voting-age population in 1990 compared to 1965 accounts for the observeddecline in the relative capital tax rate between those two years. A younger population raises the net return to capital, leads voters to increase their savings,and results in a preference for lower taxes on capital. Conversely, aging might increase capital taxation

Use of Apheresis and Insulin for Hypertriglyceridemia-induced Pancreatitis and Diabetic Ketoacidosis

CLINICAL RELEVANCE Acute pancreatitis (AP) is a common gastrointestinal disease that may result in multiple organ failure and death1 – Gallstones & alcohol are the most common causes of AP1 – Hypertriglyceridemia (HTG) causes 1-4% of cases, and should be suspected if triglycerides (TG) are \u3e 1,000 mg/dL in the absence of gallstones or history of significant alcohol use1 – Clinical management of hypertriglyceridemia-induced pancreatitis (HTGP) is based primarily on anecdotal evidence and case reports Concurrent diabetic ketoacidosis (DKA) and AP have been described in the literature – DKA may be a risk factor for AP, but it is uncertain if AP triggers DKA or vice-versa2 – The optimal management of patients that present with AP, HTG, and DKA is unknown2,

Methemoglobinemia in Acetaminophen Overdose and Glucose-6-phosphate Dehydrogenase Deficiency

Background: Methemoglobin (MetHb) is formed when the iron moiety of hemoglobin (Hgb) is oxidized from ferrous (Fe2+) to ferric (Fe3+) state à impaired O2 delivery to tissues Acetaminophen Metabolism: ~90% is metabolized in liver via sulfation and glucuronidation remainder is metabolized via CYP450 to a toxic oxidizing agent, N-acetyl-p-benzoquinone imine (NAPQI), which is detoxified via glutathione1 Acute Acetaminophen Overdose: saturates sulfation and glucuronidation pathways depletes glutathione stores leads to excess NAPQI à oxidative stress à methemoglobinemia1 MetHb Reduction Pathway: cytochrome b5 reductase removes 95% to 99% of endogenous MetHb nicotinamide adenine dinucleotide phosphate (NADPHhttp://jdc.jefferson.edu/pharmacyposters/1001/thumbnail.jp